Police Bribery & Access to Methadone Maintenance Therapy within the Context of Drug Policy Reform in Tijuana, Mexico

In 2009, Mexico passed legislation to decriminalize drug possession and improve access to addiction treatment. We undertook research to assess the implementation of the reform among a cohort of people who inject drugs (PWID) in Tijuana. This study specifically sought to determine whether discretionary policing practices like extortion impact access to methadone maintenance therapy (MMT) in Tijuana, a city characterized by high levels of drug-related harms.

Generalized estimating equation analyses were used to construct longitudinal confounding models to determine the association between paying a police bribe and MMT enrolment among PWID in Tijuana enrolled in a prospective cohort study. Outcome of interest was MMT enrolment in the past six months. Data on police interactions and MMT enrolment were also obtained.

Between October, 2011 and September, 2013, 637 participants provided 1825 observations, with 143 (7.8%) reports of MMT enrolment during the study period. In a final confounding model, recently reporting being forced to pay a bribe to police was significantly associated with an increased likelihood of accessing MMT (adjusted odds ratio=1.69, 95% confidence interval: 1.02-2.81, p=0.043). However, in 56 (39.2%) cases, MMT enrolment ceased within six months. The majority of participant responses cited the fact that MMT was too expensive (69.1%).

Levels of MMT access were low. PWID who experienced police extortion were more likely to access MMT at baseline, though this association decreased during the study period. Coupled with the costs of MMT, this may compromise MMT retention among PWID.

Via: http://ht.ly/S74pX 

By:  Werb D1, Wagner KD2, Beletsky L3, Gonzalez-Zuniga P2, Rangel G4, Strathdee SA5.

• 1Division of Global Public Health, Department of Medicine, University of California, San Diego, United States; BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.
• 2Division of Global Public Health, Department of Medicine, University of California, San Diego, United States.
• 3Division of Global Public Health, Department of Medicine, University of California, San Diego, United States; Northeastern University School of Law, Bouvé College of Health Sciences, Boston, United States.
• 4Secretaria de Salud de Baja California, Tijuana, Mexico.
• 5Division of Global Public Health, Department of Medicine, University of California, San Diego, United States. Electronic address: sstrathdee@ucsd.edu.